MEDICARE: TRUMAN AND DOUGHERTY ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1467220335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUMAN AND DOUGHERTY ORTHODONTICS

Provider Business Mailing Address
First Line	:	10000 W SAHARA AVE STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6072
Country	:	US
Telephone Number	:	702-360-9000
Fax Number	:	702-320-9045

Provider Business Practice Location Address
First Line	:	10000 W SAHARA AVE STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6072
Country	:	US
Telephone Number	:	702-360-9000
Fax Number	:	702-320-9045

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KELSEY WILLMAN
Credential	:
Telephone Number	:	702-360-9000

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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